Table 1 Timeline of the case report
From: A compulsive act of excess water intake leading to hyponatraemia and rhabdomyolysis: a case report
Time point | Clinical features | Investigations | Management |
|---|---|---|---|
2 weeks prior to hospital admission | • Left-sided renal colicky type pain | • Radiography—left mid ureteric calculus | • Reassured and requested to consume plenty of water |
2 days prior to hospital admission | • Consumed about 10 l of water per day and developed polyuria, fever, dark urine, generalized weakness and altered level of consciousness | • None | • None |
On the day of hospital admission | • One episode of generalized tonic-clonic seizure • Disoriented in place, person and time • GCS—9 (motor—5, verbal—2, eye—2) | • Serum sodium—119 mmol/L • Serum potassium—2.9 mmol/L • Serum osmolality—242 mOsm/kg of water • Urine osmolality—195 mOsm/kg of water • Non-contrast CT brain—normal | • IV cefotaxime (2 g 6 hourly) • IV acyclovir (500 mg 8 hourly) • IV dexamethasone (2 mg 6 hourly) • IV 3% hypertonic NaCl single bolus (100 mL over 20 min) • IV KCl single infusion (40 mmol over 12 h) • Fluid input per hour = previous hours output + 20 mL |
Day 3 | • GCS—15 (motor—6, verbal—5, eye—4) | • Serum sodium—136 mmol/L • Serum potassium—3.8 mmol/L • Creatinine phosphokinase—10,000 U/L • Myoglobinuria—positive | • Fluid input per hour = previous hours output + 20 mL • IV antibiotics continued |
Day 4 | • Clinically stable | • AST—2316 U/L • ALT—463 U/L | • Fluid input per hour = previous hours output + 20 mL • IV antibiotics continued |
Day 5 | • Clinically stable | • Serum osmolality—342 mOsm/kg of water • Urine osmolality—869 mOsm/kg of water | • Fluid input per hour = previous hours output + 20 mL • IV antibiotics continued • IV dexamethasone omitted |
Day 7 | • Clinically stable | • AST—1383 U/L • ALT—488 U/L • Creatinine phosphokinase—54,841 U/L | • Normal fluid intake per day • IV antibiotics continued |
Day 9 | • Clinically stable | • AST—702 U/L • ALT—398 U/L • Creatinine phosphokinase—18,070 U/L | • Normal fluid intake per day • IV antibiotics continued |
Day 11 | • Clinically stable | • AST—240 U/L • ALT—232 U/L • Creatinine phosphokinase—1419 U/L | • Normal fluid intake per day • IV antibiotics omitted |
Day 15 | • Clinically stable | • AST—66 U/L • ALT—78 U/L • Creatinine phosphokinase—49 U/L | • Discharged with appropriate medical advice to prevent similar complications |